Endoscopic surgery, i.e., minimally invasive access to a cavity of a patient's body, such as the abdominal cavity, is typically performed through the use of miniaturized optical and surgical instruments. In the case of laparoscopic surgery, which concerns the peritoneal cavity, the cavity is essentially virtual from the surgeon's perspective and cannot be explored by optical instruments. To provide the cavity with more substance or space, its walls are raised by insufflation of gas, generally CO2, to form a gas chamber, known as a pneumoperitoneum. Access to the pneumoperitoneal chamber is accomplished using trocars or small incisions that are fit with a valve, so that communication between the interior and exterior of the abdomen occurs without significant variation in actual pressure of the gas. Surgical instruments may then be inserted through the trocars with optics connected externally to a television camera and, in turn, to a monitor, thereby forming a take and image transmission system.
Even if the pressure exerted on the patient's organs by the pneumoperitoneum causes spontaneous haemostasis of countless capillaries as may have been lesioned in forming the pneumoperitoneum, it is considered necessary that perfect haemostasis be achieved throughout. Otherwise, visibility inside the cavity may be so reduced as to make it impossible, or at least inadvisable, to continue laparoscopic surgery without risk to the patient's safety. Normally, during laparoscopic procedures, outflowing blood and other bodily fluids are aspirated to keep the surgical site clean and ensure adequate instrument visibility. While useful, aspiration is not only inefficient to implement, but it also requires several seconds to commence the aspiration process, which delay is unfortunately often decisive. As an alternative, use of forceps to insert absorbent plugs through a trocar at the surgical site has been found similarly inefficient.
In one arrangement, an instrument is provided for inserting a haemostatic plug into the abdominal cavity during laparoscopic surgery. Such instrument includes a tubular element for receiving a plug of haemostatic material and a sliding plunger for applying the plug directly where bleeding has occurred.
One disadvantage of these arrangements is that recovery of the plug using a forceps can be laborious and even dangerous, especially during laparoscopic surgery for removal of a tumor. More specifically, during this procedure, the dissemination of cells, including those that may be cancerous, as is caused by partial squeezing of the plug as it passes through the trocar, may take place at a site far from where the tumor developed. Such dissemination, in turn, may cause serious remote neoplastic dissemination which is difficult to treat. Because the plug becomes soaked with blood or other bodily fluids, there is also considerable risk that the surgeon may either be unable to find and remove the plug, or will simply “forget” about the plug after it has been introduced into a patient's body cavity, often leading to medical and legal disputes. While these disputes are generally less frequent in laparoscopic surgery than in traditional or “open” surgery, the risk is still considered significant.